D2 Development

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Your facility will enter the D2: Development Phase after successfully completing the three tasks of the D1: Discovery Phase, and submitting its Development Phase fee to Baby-Friendly USA (BFUSA). Once received, BFUSA will provide your facility with a Registry of Intent certificate and access to the online Development Phase tool kit.  

The online Development Phase tool kit contains a number of tools and planning templates intended to facilitate your facility's progress through this phase of the 4-D Pathway. Feedback is available from BFUSA staff during this phase.  In addition, facilities are invited to join the Baby-Friendly list serve for peer-to-peer discussions once they enter the Development PhaseInstructions about signing up for the list serve will be emailed to registered users once the facility has been accepted into the Development Phase.

During the Development Phase, your facility will develop a comprehensive plan for achieving, and sustaining, Baby-Friendly benchmarks consistent with the Ten Steps to Successful Breastfeeding.  There are six primary tasks that must be accomplished during the Development Phase.  Your facility must: (1) convene a Baby-Friendly Committee or Task Force; (2) develop a Baby-Friendly Hospital Initiative work plan; (3) develop an Infant Feeding Policy that supports breastfeeding as the normal method of infant feeding and addresses all Ten Steps to Successful Breastfeeding; (4) develop a staff curriculum and/or training plan; (5) develop prenatal and postpartum teaching plans; and (6) design a data collection plan.  All plans developed during this phase are reviewed by BFUSA before the facility moves on to the D3: Dissemination Phase

Convene a Baby-Friendly Committee or Task Force

Your facility should convene a multi-disciplinary Task Force of individuals responsible for successfully guiding your hospital or birthing center through the 4-D Pathway.  The online Development Phase tool kit suggests key staff to participate on your Task Force.  Be sure to include some Baby-Friendly Champions.

Develop a Baby-Friendly Hospital Initiative work plan

The online Development Phase tool kit provides model action plans to assists facilities in drafting a work plan that will lead to practice change that is both comprehensive and sustainable.  The work plan should address issues identified in the Self-Appraisal Tool completed during the Discovery Phase as well as a review of the maternity care practices that impact infant feeding outcomes. 

Your facility's work plan will be submitted to BFUSA for review and comments. 

Develop a Comprehensive Hospital/ Birthing Center Infant Feeding Policy

A fundamental premise of the BFHI is that the hospital policy drives practice.  Step 1 of the Ten Steps to Successful Breastfeeding requires the development a comprehensive infant feeding policy that establishes breastfeeding as the norm and describes how the remaining steps will be practiced at the facility.  As the policy development materials contained in the online Development Phase tool kit indicate, the BF Task Force should include all facility practices that could potentially impact breastfeeding success. 

Your infant feeding policy policy will be submitted to BFUSA for review and comments.

Develop a Staff Training Plan/Curriculum 

The purpose of your Baby-Friendly Staff Training Plan/Curriculum is to ensure that your facility has a comprehensive plan for teaching the knowledge and practical skills necessary to implement your facility's breastfeeding policy.  The online Development Phase tool kit provides details on who should be trained and what content should be included in the training.

As with other planning documents prepared during this phase, your facility's staff training curriculum and/or training plan will be submitted to BFUSA for review and feedback.

Develop Prenatal and Postpartum Teaching Plans

This step requires that your facility develop teaching plans for use with prenatal and postpartum women at your hospital or birthing center.  As detailed in the Development Phase tool kit, these teaching plans should support and enhance your facility's breastfeeding policy. 

Your teaching plan will be submitted to BFUSA for review.  

Design a Data Collection Plan

Success during the D2: Development Phase will require implementation of quality improvement indicators. The first step in this process is for your facility to design data collection tools and plans.  The Development Phase tool kit contains guidance on designing your facility's data collection plan.  BFUSA staff will also provide technical assistance following their review of your proposed data collection plan.   

Your Data Collection Plan will be submitted to BFUSA for review and feedback.

Baby-Friendly USA Review of Development Phase Materials

The responsibility of BFUSA as the designating body in the United States for the international Baby-Friendly Hospital Initiative is to assess practice in facilities that offer birthing services to women.  The focus of practice assessment is to ensure that it meets the criteria for evaluation in relation to the Ten Steps to Successful Breastfeeding and compliance with the International Code of the Marketing of Breast Milk Substitutes.   BFUSA utilizes the most current edition of the Baby-Friendly Hospital Initiative Guidelines and Evaluation Criteria as the basis for the Baby-Friendly Designation process.

BFUSA will review and provide feedback on hospitals’ preliminary written policies, work plans, staff and patient education plans, and data collections plans during the Development phase to ensure that all necessary components are addressed.  This is not, and should not be considered plan approval.  We do not reject or accept hospitals’ plans; we simply see this as an excellent opportunity to provide feedback on the plans in accordance with the Guidelines and Criteria for Evaluation.  In addition, BFUSA will not address practice guidelines that do not directly pertain to the Guidelines and Evaluation Criteria assessed by BFUSA.   It is recommended that all guidelines within the policies be founded in current evidence.

Movement to the Dissemination Phase

Once your facility has successfully completed the six tasks detailed above, submitted a letter indicating your readiness to move to the next phase, and submitted the Dissemination Phase fee, Baby-Friendly USA will mail your facility a Registry of Intent award and will provide your hospital or birthing center with the online Dissemination Phase tool kit.  Receipt of the Development Phase - Certificate of Completion award acknowledges your facility's acceptance into the D3: Dissemination Phase of the 4-D pathway.

Link to D3: Dissemination Phase

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